One of the biggest challenges and opportunities with the implementation of the Affordable Care Act is the chance to cover more low income families–not just kids, as we’ve done very successfully with Apple Health for Kids. However, unlike typical middle class families, low income families are more likely to have fluctuations in their monthly income, which creates an additional hurdle for these families when applying for income based insurance programs.

Based on how the current system is supposed to work, if you are Medicaid eligible (adult with an income level below 138% of the Federal Poverty Level, at or below $32,499 for a family of four) when you sign up for insurance coverage through the Washington Benefits Exchange you would be assigned to one of five Medicaid plans. However, if you got a better paying job and your income level rose above the 138% of Federal Poverty Level, then you would have to go onto the Exchange to select a new plan and pay the premium. That new plan may or may not have your doctor in their network. If the Medicaid plans were in the Exchange, it would be a seamless shift for the person because they would keep their current doctor and pay the difference after their subsidy went into effect. Without any of the Medicaid plans in the Exchange, the burden of making those changes rests with the consumer. For those of us tracking this closely, we call it call it “churn.” From our perspective, one of the biggest promises of the Affordable Care Act is to ensure continuity of care for our most vulnerable populations and minimize the impact of churn on a family receiving health care.

I don’t know about you, but I think insurance and health care are already pretty complicated. The thought of having to switch my insurance plans when my income level changes would be overwhelming especially if I was new to having insurance, struggling to pay rent or feed my kids and make good parenting decisions.

I know that the launch of the Health Benefits Exchange is hard work and there will be some bumps along the way but I sure hope the Insurance Commissioner’s office will revisit this decision for the sake of the most vulnerable families in our community.